Research On The Financial Input Performance Of County Public Hospitals In Anhui

Objectives In order to finding out the problems and weak links in the financial input and improving the efficiency of financial investment,we have found out the situation of financial investment of county public hospitals in Anhui,explored the effects of different financial input levels,structure and the input expenditure ratio on hospital performance,and analyzed the changes of hospital' output indicators under different levels of financial subsidies.Methods Through literature review to understand the evaluate experience of public hospital' financial investment performance in domestic and foreign country,and access to documents to understand the relevant departments regulations of financial investment in public hospitals,so to provide ideas and reference for the research plan and the index system construction;Exchange the information of financial investment of county hospitals,discuss and modify the initial evaluation index system by seminar;using the Delphy to determine the evaluation index system and weight;collect the present situation,existing problems and relevant suggestions of financial investment by in-depth interviews;make a survey on sample hospitals which is covering three parts: the basic situation of the sample hospitals,hospital expenses and hospital operations;Using Epi Data 3.1,Excel 2003 and SPSS16.0 for data entry,processing and analysis respectively.Using descriptive analysis,t test,variance analysis,correlation analysis,multiple regression to understand the financial investment status and performance scores of sample hospitals,find out the relationship between the financial investment factors and investment performance,and demonstrate the impact of fiscal subsidy level on hospital outputs.Results Financial investment:(1)Subsidy income and proportion:the input is increasing in 2013-2015,the growth rate of financial investment in 2015 was higher than that in 2014 significantly,which reached 14.4%,but the ratio of subsidy income in hospital income has declined,the proportion of fiscal subsidy is still not high.The fiscal subsidy proportion is 9.4% in 2015,half of hospitals is less than 7.8%,only 25% hospitals is more than 10%.At the same time,the fiscal subsidy proportion is different in regional(minimum 1.6%,maximum 29.1%).From the perspective of hospitals type,the financial investment amount is growing in county-level general hospitals,but its growth rate in 2015 is dropped by nearly 7 percentage than that in 2014.The traditional Chinese medicine hospitals is not only grow negatively in 2014,but also has a larger gap than county-level general hospitals.Besides,the ratio of financial subsidies in county-level general hospitals showed an increasing trend,while the traditional Chinese medicine hospitals were declined yearly,compared with 2013,it has fell 3.6% in 2015.(2)Input structure and distribution:In the financial subsidy income,the ratio of retirees funds was between 22.7%-26.8% each year,88.6% sample hospitals received the subsidy in 2015;while the ratio of on-the-job personnel funds was lower than15.2% for each year,45.5% hospitals received the subsidy in 2015,but only 9 of the sample hospitals' staff funds accounted for the actual expenditure is more than 10%.(3)Revenue and expenditure of input project:the on-the-job personnel expenses,retirees expenses,basic construction and equipment purchase subsidies were over expenditure in 2015.Among them,the funds for on-the-job personnel and basic construction accounted for the actual expenditure is 5.3% and 68.1%.The performance score: The overall performance score of the sample hospitals was 825.6±72.0.From the perspective of each dimension,the score of medical services,social services,integrated management and social evaluation were 209.7±20.9,205.8±16.9,203.5±18.1,and 206.6±18.4 accordingly.Regardless of the total score or dimension score,the traditional Chinese medicine hospital was lowerthan the county-level general hospitals,but only the difference of "social services" score was significantly(P<0.05).Factors influencing the performance of financial input:On the level of investment,the fiscal subsidy proportion has an positive effect on the performance score;as far as investment structure is concerned,the ratio of on-the-job personnel funds and basic construction funds were affect the hospital's financial performance(P< 0.01),and the larger the ratio of staff and basic construction funds is,the higher the hospital performance score;on the investment project budget ratio,the funds of total financial subsidies,on-the-job personnel and basic construction in expenditure were affect the financial investment performance score(P<0.05),and the larger the financial assistance,the greater funds share of the actual expenditure on personnel and basic construction,the higher the performance score is.Effects of financial subsidy level on hospitals' output index: The proportion of staff expenditure and fiscal subsidy levels were positively correlated,while the average cost of inpatients,average cost of outpatients,drugs income ratio,asset-liability ratio were negatively correlated with financial subsidy levels.And the scores was different between groups of each index(P<0.05).Conclusions In general,the financial investment of county-level public hospitals is growing in Anhui,but the investment level is still not high,and the input distribution is not balanced,the subsidy level of traditional Chinese medicine hospital is low relatively.At the same time,the structure of financial investment is not reasonable,only a small number of hospitals received staff funds and infrastructure subsidies,and the subsidies are not in place,a larger proportion of expenditure to be resolved by hospitals.In addition,the proportion of financial subsidies,investment structure and the ratio of revenue in expenditure have an effect on the county-level public hospitals' performance.The level of financial subsidies have a certain effect on personnel expenditure ratio,average cost of inpatients,average cost of outpatients,drugs income ratio and asset-liability ratio.Therefore,the government should find out the financial situation andhospitals operation thoroughly,so that to establish a long-term investment mechanism,optimize the investment structure,make all retirees wages into the budget management,increase staff subsidies,and resolve the hospitals' historical debts gradually.At the same time,strengthen the evaluation of financial input performance,and linked the results to financial investment,thus to improve the efficiency of financial funds.